Cataract Surgical Information Package

CATARACT SURGICAL INFORMATION PACKAGE

                                   

5400 Portage Road, suite 5, Niagara Falls, Ontario, L2G 5X7, Canada

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TABLE OF CONTENTS

Welcome to Peninsula Eye Associates…………................................................................3

How the Eye Works............................................................................................................4

Refractive Errors ..............................................................................................................4-5

How do Cataracts develop..................................................................................................6

What are the symptoms of a Cataract… ............................................................................7

How is a Cataract detected..............................................................................................8-9

What are the different types of intraocular lenses after cataract surgery……………..9-11

What happens before/during/after the surgery….........................................................12-13

What are the risks with cataract surgery............................................................................14

Important information for contact lens wearers.................................................................15

Activity recommended activity schedule following surgery…….....................................16

Dr. Andrew Taylor Biography…. .....................................................................................17

WELCOME!

Your vision is a precious commodity, so we appreciate the trust you’ve put in Peninsula Eye

Associates and Dr. Taylor to perform your cataract procedure. We know this procedure has the potential

to change your life immensely and this is an exciting time for you, anticipating the comfort of being able

to perform daily activities without glasses or contacts. We will carefully evaluate your eyes to determine

if you have any underlying conditions, such as nearsightedness, farsightedness, presbyopia, glaucoma,

or retinal problems. We will discuss all the lifestyle lenses that you may be a candidate for and help you

make an informed decision on which lens implant.will be best suited for your needs.

This is also a time to gather information. In our experience, a well-informed patient with realistic

expectations has the most satisfying outcome. This information package should answer most of your

questions, providing details regarding benefits, potential complications, and steps of the procedure.

Peninsula Eye Associates mission, is to deliver premium quality care, using the highest surgical

standards with the latest in technology, and the most experienced and dedicated staff and surgeon. This

allows us to give you uncompromising patient care. Dr. Andrew Taylor has performed more than 20,000

procedures including one of three procedures.

 CAT ( Cataract surgery)

 RLE ( Refractive Lens Exchange or sometimes called Clear Lens Extraction, or CLE)

 Phakic (IOL) Implantation (Phakic Intraocular Lens Implantation or sometimes called

Intraocular Contact Lens Implantation)

RLE, Phakic Iol Implantation and CAT are referred to, as the “procedure” in the following surgical

information package, and are briefly described below.

RLE and CAT are forms of outpatient lens surgery in which a surgeon starts by anesthetizing and

entering the anterior chamber of the eye through a microscope port incision in the clear membrane,

called the cornea of the eye. The surgeon that uses a specialized and precise instrument, called a

phacoemulsifier, to remove the lens of the eye. The lens is then replaced with an artificial lens with a

power of your eye. These measurements are usually in agreement with recent with recent prescriptions

for your glasses and/or contact lenses. Within minutes, natural forces seal the microincision in the

cornea. RLE and CAT can be used to correct nearsightedness (myopia), farsightedness (hyperopia), lens

opacities, and, in certain cases, when special lenses are used, some astigmatism and presbyopia. RLE is

recommended for patients over 45 years of age.

Phakic IOL Implantation is form of outpatient surgery in which a surgeon, instead of removing the

natural lens in the eye, adds an additional lens in front of it- entering the eye in the same way as RLE

and CAT. This technique is usually used for people who are under age 40 and whose natural lens is still

capable of a wide range of accommodation. The procedure is used to correct nearsightedness (myopia),

farsightedness (hyperopia) and, in certain cases, when special lenses are used, some astigmatism.



In the following pages, you will find further information about the procedures, as well as information

about the conditions that cause you to require visual correction, and the steps to follow before and after

your procedure. Please read all the information in this surgical package carefully.  Remember that we

provide this package in addition to, but not as a replacement for, discussions with your surgeon and

optometrist. In addition to speaking with the surgeon and optometrist, you may find it helpful to contact

one of our surgical consultants at 905-356-3311 if you have any further questions.

HOW THE EYE WORKS

Phakic IOL and RLE Implantation are performed on or around the natural lens

of the eye. The globe of the eye possesses a transparent wall at the front called

the cornea, which acts as the major focusing part of the eye (75%). The

remaining focusing power of the eye is mostly in the lens of the eye (20%) and

the tear film (5%). Consequently, changing the lens of the eye for one of a

different power produces a permanent change in its focusing power.

REFRACTIVE ERRORS

Before undergoing the procedure, it is helpful to understand how the eye works. The eye is like a

camera. The cornea is the clear, dome-shaped window that forms the front wall of the eye. The retina is

light-sensitive tissue in the back of the eye that connects to the brain and acts like the film in a camera.

The cornea at the front of the eye acts as a lens that focuses light onto the retina, producing an image on

the retina that gets transmitted to the brain and interpreted as vision. The combination of the curve of the

cornea and the power of the lens in the eye determines the focusing power and whether the incoming

light rays from distant objects focus directly onto the retina. When light does not focus directly on the

retina, the eye has a refractive error. This means that with the appropriate “refractive correction” lens,

incoming light rays become focused onto the retina producing clear vision.

You may have one or more of the following types of refractive errors:

Nearsightedness (Myopia)

Myopia occurs when light entering the eye focuses in front of the retina

instead of directly on it.  Myopia is caused by a cornea that is steeper, or

an eye that is longer, than a normal eye.  Nearsighted people typically see

well up close, but have difficulty seeing far away.



Farsightedness (Hyperopia)

Hyperopia occurs when light entering the eye focuses behind the retina,

instead of directly on it.  Hyperopia is caused by a cornea that is flatter, or

an eye that is shorter, than a normal eye.  Farsighted people usually have

trouble seeing up close, but may also have difficulty seeing far away as

well.

 Astigmatism occurs when the cornea is oval like a football instead of

spherical like a basketball.  Most astigmatic corneas have two curves – a

steeper curve and a flatter curve.  This causes light to focus on more than

one point in the eye, resulting in blurred vision at distance or near.

Astigmatism often occurs along with nearsightedness or farsightedness.

In all of these conditions, the person needs some type of corrective lens, such as glasses or contact

lenses, to focus the light properly.

CATARACTS

What is a cataract?

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are

related to aging. Cataracts are very common in older people. By age 80, more than half of

all North Americans either have a cataract or have had cataract surgery. A cataract can

occur in one eye or both eyes. It cannot spread from one eye to the other

What is the lens?

The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The

retina is the light-sensitive tissue at the back of the eye.

In a normal eye, light passes through the transparent lens to the retina. Once it reaches the

retina, light is changed into nerve signals that are sent to the brain.

The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a

cataract, the image you see will be blurred.

HOW DO CATARACTS DEVELOP?

Age- related cataracts develop in two ways:

1. Clusters of protein reduce the sharpness of the image reaching the retina.

The lens consists mainly of water and protein. When the protein clusters up, it

clouds the lens and reduces the light that reaches the retina. The clouding may

become severe enough to cause blurred vision. Most age- related cataracts develop

from protein clusters.



2. The clear lens slowly changes to a yellowish/brownish color, adding a

brownish tint to vision.

As the clear lens slowly colors with age, your vision gradually may acquire a

brownish shade. At first, the amount of tinting may be small and may not cause a

vision problem. Over time, increased tinting may make it more difficult to read and

perform other routine activities. This gradual change in the amount of tinting does

not affect the sharpness of the image transmitted to the retina.

If you have advanced lens discoloration, you may not be able to identify blues and

purples. You may be wearing what you believe to be a pair of black socks, only to find

out from friends that you are wearing purple socks.

Who is at risk for cataract?

The risk of cataract increases as you get older. Other risk factors for cataract include:

 Certain diseases (for example, diabetes).

 Personal behavior (smoking, alcohol use).

 The environment (prolonged exposure to ultraviolet sunlight).

WHAT ARE THE SYMPTOMS OF A CATARACT?

 Cloudy or blurry vision.

 Colors seem faded.

 Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear

around lights.

 Poor night vision.

 Double vision or multiple images in one eye. (This symptom may clear as the

cataract gets larger.)

 Frequent prescription changes in your eyeglasses or contact lenses.

These symptoms also can be a sign of other eye problems. If you have any of these

symptoms, check with your eye care professional.

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Are there other types of cataract?

Yes. Although most cataracts are related to aging, there are other types of cataract:

 Secondary cataract. Cataracts can form after surgery for other eye problems, such

as glaucoma. Cataracts also can develop in people who have other health problems,

such as diabetes. Cataracts are sometimes linked to steroid use.

 Traumatic cataract. Cataracts can develop after an eye injury, sometimes years

 Congenital cataract. Some babies are born with cataracts or develop them in

childhood, often in both eyes. These cataracts may be so small that they do not

affect vision. If they do, the lenses may need to be removed.

 Radiation cataract. Cataracts can develop after exposure to some types of

radiation.  

                                                                                                                         

Normal Vision                       Vision with a Cataract

HOW IS A CATARACT DETECTED?

Cataract is detected through a comprehensive eye exam that includes:

 Visual acuity test. This well you see at various distances.

 Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils.

Your eye care professional uses a special magnifying lens to examine your retina

and optic nerve for signs of damage and other eye problems. After the exam, your

close-up vision may remain blurred for several hours.

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 Tonometry. An instrument measures the pressure inside the eye. Numbing drops

may be applied to your eye for this test.

Your eye care professional also may do other tests to learn more about the structure and

health of your eye.

How is a cataract treated?

The symptoms of early cataract may be improved with new eyeglasses, brighter lighting,

anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the

only effective treatment. Surgery involves removing the cloudy lens and replacing it with

an artificial lens.

A cataract needs to be removed only when vision loss interferes with your everyday

activities, such as driving, reading, or watching TV. You and your eye care

professional can make this decision together. Once you understand the benefits and risks

of surgery, you can make an informed decision about whether cataract surgery is right for

Sometimes a cataract should be removed even if it does not cause problems with your

vision. For example, a cataract should be removed if it prevents examination or treatment

of another eye problem, such as age-related macular degeneration or diabetic retinopathy.

If you have cataracts in both eyes that require surgery, the surgery will be performed on

each eye at separate times.

DO I REQUIRE AN INTRA OCULAR LENS IMPLANT AT THE
TIME OF CATARACT SURGERY?

Yes, all patients have an implant of a specific power. After the cataract is removed it is

essential to have an intra-ocular lens (IOL) implant, otherwise “coke-bottle” or extremely

thick glasses are required to provide focus for clear vision in normal patients. The lens, or

cataract, normally focuses the light on to the back of the eye for clear vision. An IOL

implant will provide this focus and obviate the need for thick glasses.

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HOW IS THE POWER OF THE IOL IMPLANT DETERMINED?

The implant power can be determined by a variety of methods. The most accurate

measurement is by laser interferomotry with the Carl Zeiss  IOL Master, which uses no-

touch optical methods to determine the length of the eye and the curvature of the front of

the eye. Unlike with the traditional A-scan ultrasound method, no drops are required and

nothing touches the eye. This non-contact method of obtaining biometry eye

measurements prevents false readings which can be encountered with the touch method

the A-scan which can produce deformation of the eye and false readings. The information

that is calculated is then inputted into a complex formula to determine the ideal power of

the implant. In some situations, with a very advanced cataract, it is difficult to achieve an

accurate calculation of the implant power.

Are there different types of IOL implants?

Yes, there are a number of different types of intra-ocular (IOL) implants. The main

classifications of implants are the standard spherical monofocal, aspheric (high

definition) monofocal, aspheric toric monofocal, aspheric mutifocal and aspheric toric

multifocal. Different lenses are selected to provide different ranges and qualities of vision

based upon the patients requirements and ocular health.

The standard spherical monofocal implant is provided by the Ontario Health Insurance

Program (OHIP) at no charge. This is a monofocal lens implant that can provide

satisfactory vision at one fixed and specified distance. Generally, it requires the aid of

glasses to fine tune sight for clear vision at other working distances. Patients opting for

this lens should expect to be wearing bifocal glasses after their cataract surgery.

Additional types of implants are not covered by OHIP but can be purchased by the

patient through their health care facility. One of the great advantages of these lenses is

that the shape of the lens improves the optics of the eye and the overall quality of vision.

Monofocal Lens: The standard IOLs are monofocal. This means that they offer clear

vision at one distance only; generally far away. They definitely are an improvement over

the cataractous lens that is replaced during surgery, which provides cloudy, blurred vision

at all distances. Traditional IOLs mean that you must wear eyeglasses or contact lenses in

order to read, use a computer or view objects at arm's length.

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1. Aspheric Monofocal Lens: The aspheric monofocal lens implant only corrects

distance for far vision, such as that required for driving. The aspheric monofocal lens

implant does not usually correct intermediate or "arms length" vision, such as that

required for viewing computer screens, and does not correct near vision as required

for reading. Patients who wish to have the best quality of distance vision, especially

in dim or dusky conditions, should consider an aspheric monofocal lens implant.

Please remember that it will still be necessary to wear reading glasses or bifocals to

correct for intermediate and near vision tasks.

2.  Toric Monofocal Lens: Toric monofocal lenses have more power in one specific

region in the lens to correct astigmatism as well as distance vision. Due to the

difference in lens power in different areas, the correction of astigmatism with a toric

monofocal lens requires that the lens be positioned in a very specific configuration.

While toric monofocal lenses can improve distance vision and astigmatism, the

patient still will require corrective lenses for all near tasks, such as reading or

3. Multifocal Lens: Multifocal intraocular lenses are one of the latest advancements in

lens technology. These lenses have a variety of regions with different power that

allows some individuals to see at a variety of distances, including distance,

intermediate, and near. While promising, multifocal lenses are not for everyone.

They can cause significantly more glare than monofocal or toric lenses. Multifocal

lenses cannot correct astigmatism, and some patients still require spectacles or

contact lenses for clearest vision.

Why does OHIP only cover the cost of a standard implant?

OHIP covers all medically necessary implants and procedures. The premium lenses, such

as the aspheric monofocal implant, toric monofocal implant, and multifocal implant are

considered elective lenses to decrease the need for glasses. These implants are not

considered medically necessary and are offered at additional cost to the patient.

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WHAT HAPPENS BEFORE THE CATARACT SURGERY?

Before surgery, your doctor will do some diagnostic testing. These tests may include

measuring the curve of the cornea and the size and shape of your eye. This information

helps your doctor choose the right type of IOL.

Can I eat prior to my cataract operation?

Nothing by mouth after midnight on the night before your cataract surgery.

Should I take my own medications on the day of my surgery?

Do not take your medication the morning of your cataract surgery.  Take your medication

with you to the hospital. Your medication will be administered by the nurse following

your surgery. This includes insulin for diabetic patients.

What happens during the procedure?

At the hospital or eye clinic, drops will be put into your eye to dilate the pupil. The area

around your eye will be washed and cleansed. The operation usually lasts less than one

hour and is almost painless. Many people choose to stay awake during surgery.

Others may need to be put to sleep for a short time. If you are awake, you will have an

anesthetic to numb the nerves in and around your eye.

After the operation, a patch may be placed over your eye. You will rest for a while. Your

medical team will watch for any problems, such as bleeding. Most people who have

cataract surgery can go home the same day.

You should not drive for at least twenty-four (24) hours after either procedure and

in no event should you drive until your vision is clear.

What happens after surgery?

Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is

also common. Your eye may be sensitive to light and touch. If you have discomfort, your

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doctor can suggest treatment. After one or two days, moderate discomfort should

For a few days after surgery, your doctor may ask you to use eyedrops to help healing

and decrease the risk of infection. Ask your doctor about how to use your eyedrops, how

often to use them, and what effects they can have. You will need to wear an eye shield or

eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye.

When you are home, try not to bend from the waist to pick up objects on the floor. Do not

lift any heavy objects. You can walk, climb stairs, and do light household chores.

In most cases, healing will be complete within eight weeks. Your doctor will schedule

exams to check on your progress.

Can Problems Develop After Surgery?

Problems after surgery are rare, but they can occur. These problems can include infection,

bleeding, inflammation (pain, redness, and swelling), loss of vision, double vision, and

high or low eye pressure. With prompt medical attention, these problems usually can be

treated successfully.

Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your

vision. This condition is called an after-cataract. An after-cataract can develop months or

years after cataract surgery.

An after-cataract is treated with a laser. Your doctor uses a laser to make a tiny hole in

the eye tissue behind the lens to let light pass through. This outpatient procedure is called

a YAG laser capsulotomy. It is painless and rarely results in increased eye pressure or

other eye problems. As a precaution, your doctor may give you eyedrops to lower your

eye pressure before or after the procedure.

When will my vision be normal again?

You can return quickly to many everyday activities, but your vision may be blurry. The

healing eye needs time to adjust so that it can focus properly with the other eye,

especially if the other eye has a cataract. Ask your doctor when you can resume driving.

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If you received an IOL, you may notice that colors are very bright. The IOL is clear,

unlike your natural lens that may have had a yellowish/brownish tint. Within a few

months after receiving an IOL, you will become used to improved color vision. Also,

when your eye heals, you may need new glasses or contact lenses.

What can I do to protect my vision?

Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay

cataract. If you smoke, stop. Researchers also believe good nutrition can help reduce the

risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and

other foods with antioxidants.

If you are age 60 or older, you should have a comprehensive dilated eye exam at least

once every two years. In addition to cataract, your eye care professional can check for

signs of age-related macular degeneration, glaucoma, and other vision disorders. Early

treatment for many eye diseases may save your sight.

What are the risks with cataract surgery?

As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before

cataract surgery, your doctor may ask you to temporarily stop taking certain medications

that increase the risk of bleeding during surgery. After surgery, you must keep your eye

clean, wash your hands before touching your eye, and use the prescribed medications to

help minimize the risk of infection. Serious infection can result in loss of vision.

Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders,

such as high myopia (nearsightedness), can further increase your risk of retinal

detachment after cataract surgery. One sign of a retinal detachment is a sudden increase

in flashes or floaters. Floaters are little "cobwebs" or specks that seem to float about in

your field of vision.

If you notice a sudden increase in floaters or flashes, see an eye care professional

immediately. A retinal detachment is a medical emergency. If necessary, go to an

emergency service or hospital. Your eye must be examined by an eye surgeon as soon as

possible. A retinal detachment causes no pain. Early treatment for retinal detachment

often can prevent permanent loss of vision. The longer the retina stays detached, the less

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likely you will regain good vision once you are treated. Even if you are treated promptly,

some vision may be lost.

IMPORTANT INFORMATION FOR CONTACT LENS WEARERS

Contact lenses can “mold” the corneal surface, which changes the corneal curvature and

may lead to a change in your refraction (prescription). In order to properly calculate the

treatment to correct your refractive error, you will have to stop wearing contact lenses at

some stage prior to your appointments. In time, the cornea will return to its natural shape

and size. Peninsula Eye Associates is dedicated to providing you with the most accurate

treatment, and this can only be achieved if the corneal surface is stable and back to its

For the vast majority of patients, the recommended minimum length of time for contact

removal should suffice. However, the individual rate of corneal adjusting may vary. If

your cornea is still adjusting at either the pre-operative or surgery appointment, you will

be required to reschedule your appointment for a later date. This will allow the cornea to

return to its natural shape and refraction to stabilize, thus providing you with an

opportunity to attain the best possible outcome.

Removal of Contact Lenses Prior to the Pre-operative Evaluation and Surgery

Appointments

Contact Lens Type Length of time to be out of

All SOFT contacts Minimum 72 hours Minimum 48 hours

Rigid Gas Permeable (worn for

more than 20 years)

True Hard Lenses

(Polymethyl-methacrylate)

Before Surgery

contacts

Minimum 2 weeks Minimum 48 hours

Minimum 2 weeks Minimum 48 hours

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RECOMMENDED ACTIVITY SCHEDULE FOLLOWING UNCOMPLICATED SURGERY 

Day of Surgery

Day 3 activities

Day 7 activities

Day 14 activities  Hockey.

month with eye

months with eye

 The day of surgery should be a day of rest.

 Always be very careful about activities where the eye may be   poked rubbed or

touched.

 Always avoid rubbing eyes – instead, use lubricant drops for irritation.

 Avoid staring without lubricating the eyes.

 Take a bath instead of a shower. Avoid soap and water in the eyes.

 Shower (but continue to avoid any soap or water in the eyes).

 Restrict movement to light activities. Work should probably be avoided. Work

at home is acceptable.

 Driving short distances after the eye examination is acceptable if adequate

vision is confirmed at the post-operative evaluation.

 Reading, watching TV and computer work is acceptable, but it is very important

to keep eyes well-lubricated.

 Flying in airplanes is acceptable but keep eyes generously

             lubricated (every 30 minutes) – airplanes have very dry air.

 Apply face makeup (but not eye makeup).

 Do office work.

 Light exercise (e.g. treadmill, Stairmaster, stationary bike).

 Playing with children (be careful).

 Moderate alcohol consumption may be resumed.

 Lifting weights.

 Applying eye makeup (avoid touching the eyes).

 Jogging outdoors.

 Rollerblading.

 Relaxed bicycling (no mountain biking).

 Playing golf.

 Sun-tanning and salon tanning (wear eye protection)

 Motorcycling; snowmobiling; boating (wear eye protection).

 Skiing (with caution and eye protection).

 Racquet sports – tennis, squash, racquetball, badminton (but always

               wear eye protection).

 Swimming.

 Scuba diving; snorkeling.

 Sailing.

 Sun-tanning and salon tanning for PRK patients.

 Dirt biking; mountain biking.

 Parachuting.

 Baseball; basketball; football; soccer.

Proceed with caution as these activities have a high risk of water being

forced into the eyes:

 Water skiing; wind surfing.

 Kayaking.

 Surfing.



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Dr. Andrew Taylor, M.D., F.R.C.S.C., Dip. A.B.O. BIOGRAPHY

Dr. Taylor is a cum laude graduate of the University of Toronto.  Dr. Taylor received his medical degree

from the University of Toronto in 1991.  He then completed an internship in comprehensive internal

medicine at The Toronto Hospital, University of Toronto in 1992.  Dr. Taylor then went on to complete

his residency training in ophthalmology at the University of Toronto.  Dr. Taylor received his

Fellowship from the Royal College of Surgeons of Canada in 1995 and became a Diplomat of the

American Board of Ophthalmology in 1997.  Dr. Taylor was the recipient of numerous academic awards

including the Dr. Louis Kagal Memorial Award for excellence in ophthalmology from the University of

Toronto, Faculty of Medicine.

Dr. Taylor has been in private practice since 1995, specializing in anterior segment and refractive

surgery.  He is associated with Peninsula Eye Associates in Niagara Falls and is the former Chief of

Ophthalmology at the Greater Niagara General Hospital.

Dr. Taylor has been performing laser refractive surgery since 1995, with extensive experience in

LASIK, PRK and intraocular surgery. He has also participated as an investigator on previous FDA trials

of new technologies in refractive surgery.  Dr. Taylor has performed over 50,000 refractive procedures,

including over 10,000 custom wavefront ablations since 2001. Dr. Taylor is recognized as one of the

most experienced refractive surgeons in North America, and he lectures extensively in the field of

refractive surgery to other health care professionals. Dr. Taylor founded LASIK Niagara and is acting

Medical Director of the clinic.

Dr. Taylor is a member of the Ontario Medical Association, the Canadian Medical Association, the

College of Physicians and Surgeons of Ontario, the Royal College of Physicians of Canada, the

American Board of Ophthalmology, the American Academy of Ophthalmology, the American Society

of Cataract and Refractive Surgeons and the International Society of Refractive Surgery.

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